正文翻譯

Why are US drug prices getting much higher?

為什么美國藥品價(jià)格越來越高?

評論翻譯

Rick VonderBrink
Why does the US let drug makers set their own drug prices? Does this lead to higher drug prices here in the US?
We let drug makers set their own prices because this is a free market economy.
Tonight you will be hungry. There are three restaurants close to your house: Morton’s of Chicago steakhouse, Outback Steakhouse, and McDonald’s.
At Morton’s you will get a prime cut of meat, aged for 30 days, cooked to order by a highly trained cook, paired with a fine wine, and served with delicious side dishes by highly attentive wait staff. You will also pay over $100 for your meal.
At Outback, you will get a distinctly lower quality cut of meat, aged since this morning, served with Coors Light . You will pay around $30.
At McDonald’s, you will get the world’s most generic hamburger, fries, and a Coke, served by a teenager who’d rather be checking his phone than listening to you. You will pay $5, maybe less if you order from the value menu.
Not that in each case, when you walk away, you will not be hungry and your body will have obtained nourishment. But the experience was vastly better when you spent more.

為什么美國讓制藥商自行制定藥品價(jià)格？這會導(dǎo)致美國藥品價(jià)格上漲嗎？
我們讓制藥商自行定價(jià)，因?yàn)檫@是自由市場經(jīng)濟(jì)。
今晚你會餓的。你家附近有三家餐廳：芝加哥莫頓牛排館、澳洲鄉(xiāng)村牛排館和麥當(dāng)勞。
在芝加哥莫頓牛排店，你會得到一塊上等的肉，陳化30天，由訓(xùn)練有素的廚師烹制，配以美酒，并由細(xì)心的服務(wù)員提供美味的配菜。你還將支付超過100美元的餐費(fèi)。
在澳洲鄉(xiāng)村牛排館，你會得到一塊質(zhì)量明顯較低的肉，從今天早上開始陳化，配上銀子彈啤酒。你將支付大約30美元。
在麥當(dāng)勞，你會得到世界上最普通的漢堡、薯?xiàng)l和一杯可樂，由一個(gè)寧愿看手機(jī)也不愿聽你說話的青少年提供。你將支付5美元，如果你點(diǎn)超值菜單，可能還會少點(diǎn)。
并非每個(gè)案例都是如此，當(dāng)你離開時(shí)，你都不會餓，你的身體也會得到營養(yǎng)。但如果你花的錢越多，體驗(yàn)就會好得多。

Maybe you can’t afford to eat at the high-end steakhouse, or maybe you’d like to do it more often. You think it isn’t fair that it is that expensive. You get your local congressman to agree, and a law is passed capping the price of a meal at a restaurant at $20. You triumphantly show up at Morton’s with your $20 bill and prepare yourself for bliss.
Guess what happens? You no longer get a 24 oz cut of aged prime New York strip, because that is too expensive. The steak you do get is no longer cooked to order, the wait staff is less attentive, and the wine list consists of Two Buck Chuck. It isn’t a great experience, and you might not go back. Or you might not get the chance to, as they are likely to go out of business, because they can no longer afford their rent.
You try Outback instead, but even their food is worse. The steak is smaller and the Bloomin’ Onion is gone.
McDonald’s is unaffected, because their meal never did cost more than $20.

也許你沒錢去高級牛排館吃飯，或者你想經(jīng)常去，你認(rèn)為這么貴是不公平的。你讓當(dāng)?shù)氐膰鴷h員同意，然后通過一項(xiàng)法律，將餐館一頓飯的價(jià)格限制在20美元。你得意洋洋地出現(xiàn)在莫頓餐廳，手里拿著20美元，準(zhǔn)備迎接幸福。
猜猜會發(fā)生什么？在紐約黃金地帶，你再也買不到一份24盎司的陳年干酪，因?yàn)槟翘F了。你吃到的牛排不再是隨叫隨到的，服務(wù)員也不那么細(xì)心了，酒單上只有廉價(jià)紅酒“兩元恰克”。這不是一次很好的經(jīng)歷，你可能再也不會去了。或者你可能沒有機(jī)會了，因?yàn)樗麄兒芸赡軙飘a(chǎn)，因?yàn)樗麄冊僖哺恫黄鸱孔饬恕?br>你可以試試澳洲鄉(xiāng)村牛排館，但就連他們的食物也更糟糕。牛排變小了，洋蔥也沒了。
麥當(dāng)勞沒有受到影響，因?yàn)樗麄兊牟唾M(fèi)一直就沒有超過20美元。

This is essentially the drug market. There is always McDonald’s. There are many conditions I can treat effectively with cheap generic drugs. I have many patients who are on half a dozen meds and don’t pay more than $10 per month for any of them. These are mostly older meds that are nevertheless still effective. If it works, great.
However, we like medical progress. There are things I can treat better and more effectively now than I could 20 years ago. Innovation is expensive. Developing a new drug can cost hundreds of millions of dollars and take 10 years. Sometimes that time and money go to waste because the drug is rejected by the FDA over safety concerns (most new drugs do not make it through this process). Drug companies are not going to take the risk of making new drugs unless there is a reward at the end of the tunnel, and that reward is the profits from the initially very high prices. They get those profits primarily from the US market. Congratulations America, you fund drug development for the whole world.
But if you limit those profits with price controls, there is less risk taking, less development, and less progress. A diabetic that I treat with nothing but generic drugs is going to do much worse and die sooner than one I treat with the fancy new stuff.
Yes, it sucks if you are the one spending $$$ on meds. The meal at Morton’s was expensive, but you wanted to go there, enjoyed the meal, and will remember it fondly. Absolutely no one wants to spend $100 on medications. But not dying or losing your vision or having crippling arthritis is good too.

這就是藥品市場。那里總是有麥當(dāng)勞。我可以用便宜的仿制藥有效地治療許多疾病。我有很多病人同時(shí)服用六種藥物，每個(gè)月的藥費(fèi)都不超過10美元。這些大多是老藥，但仍然有效。如果有效，那就太好了。
然而，我們喜歡醫(yī)學(xué)的進(jìn)步。與20年前相比，我現(xiàn)在可以更有效地治療一些疾病。創(chuàng)新是昂貴的，開發(fā)一種新藥可能要花費(fèi)數(shù)億美元，耗時(shí)10年。有時(shí)，這些時(shí)間和金錢會被浪費(fèi)，因?yàn)樵撍幬镆虬踩珕栴}被美國食品藥品監(jiān)督管理局拒絕（大多數(shù)新藥都無法通過這一過程）。制藥公司是不會冒險(xiǎn)研發(fā)新藥的，除非在研發(fā)過程的盡頭有回報(bào)，而這個(gè)回報(bào)就是從最初的高價(jià)格中獲得的利潤。他們的利潤主要來自美國市場。祝賀美國，你們資助了全世界的藥物研發(fā)。
但是，如果你用價(jià)格控制來限制這些利潤，就不會承擔(dān)那么多的風(fēng)險(xiǎn)，就會減少發(fā)展，也會減少進(jìn)步。我只用非專利藥物治療的糖尿病患者會比我用新奇的藥物治療的糖尿病患者更糟糕，死得更快。
是的，如果你是那個(gè)花錢買藥的人，那就太糟糕了。這就像在莫頓餐廳吃的飯很貴，但你想去那里吃，吃得很好，會留下美好的回憶。絕對沒有人愿意在藥物上花費(fèi)100美元，但不死亡、不失明、不患致殘性關(guān)節(jié)炎也是好事不是。

Maureen Boehm
Why are prescxtion drug prices so high in the U.S. compared to the rest of the world?
Because we let them.
Read that again.
Because WE let them.
Medicare Part D specifically PROHIBITS the negotiation of drug prices.
(Some Big Pharma lobbyist, somewhere, broke out the champagne and got a huge bonus for that one.)
Just about every other country in the world, where universal health care exists, negotiates their drug costs. Those countries know that saying that the system pays only X dollars for Y drug means that effectively, that drug won’t go anyone in that country, unless Big Pharma plays ball.
The same cancer drugs that cost thousands here can be purchased in Europe for one hundred dollars.

為什么美國的處方藥價(jià)格比世界其他地方高?
因?yàn)槲覀冏屗麄冞@樣的。
再讀一遍。
因?yàn)椤拔覀儭弊屗麄冞@樣的。
醫(yī)療保險(xiǎn)D部分特別禁止就藥品價(jià)格進(jìn)行談判。
(在某個(gè)地方，一些大型制藥公司的說客打開了香檳，并因此獲得了巨額獎(jiǎng)金。)
世界上幾乎所有其他存在全民醫(yī)療保健的國家都在協(xié)商藥品成本。這些國家知道，說系統(tǒng)為Y種藥物只支付X美元的話，實(shí)際上意味著，除非大型制藥公司合作，否則這種藥物不會進(jìn)入該國的任何人手中。
同樣的抗癌藥物在美國要花幾千美元，在歐洲只要100美元就能買到。

I have a friend, with type 1 diabetes who rations her insulin because she can’t afford the five hundred dollar cost, each month. Without insulin, she will die.
I have another that can no longer pay for the rheumatoid arthritis drug, that keeps her functional, because her insurance company won’t pay the four thousand dollars a month for Enbril. It is an older drug. It used to cost seven hundred a month.
My son has severe allergies. He used to carry an Epi-pen with him everywhere. Again, a very old drug. Used to cost ninety buck for two. It went up to around eight hundred each.
Why?
Because WE let them.
Who is WE?
It’s YOU and ME.
If we don’t take action, we will continue to be like sheep going to the slaughter house.
The sheep aren’t doing anything about because, well, they’re sheep.
Don't be a sheep.

我有一個(gè)患有1型糖尿病的朋友，她需要定量使用胰島素，因?yàn)樗?fù)擔(dān)不起每月500美元的費(fèi)用。沒有胰島素，她會死的。
我還有一個(gè)無法再支付治療類風(fēng)濕性關(guān)節(jié)炎藥物的費(fèi)用，因?yàn)樗谋ｋU(xiǎn)公司不會支付每月4000美元的Enbril費(fèi)用。它是一種較老的藥物。過去一個(gè)月要花700美元。
我兒子有嚴(yán)重的過敏癥。他以前到哪都帶著腎上腺素注射器，這又是一種非常古老的藥物。以前兩支要90美元，如今每支價(jià)格漲到了800美元左右。
為什么？
因?yàn)槲覀冏屗麄冞@樣干的。
我們是誰？
是你和我。
如果我們不采取行動，我們將繼續(xù)像羊一樣走向屠宰場。
綿羊什么也不做，因?yàn)?，它們是綿羊。
不要做綿羊了。

You have the power to vote. You have the power to protest.
There is currently drugs cost legislation being considered, in Washington.
If you are interested, and it’s cool if you are not (bah), go to FightPharma.org/senate.
There you can send a letter to the senators involved in this decision.
Tell your story. Add personal comments.
Let them know that this is an issue that will determine your vote, when they come up for re-election.

你有投票的權(quán)力、你有抗議的權(quán)力。
目前，華盛頓正在考慮就藥品成本立法。
如果你感興趣，如果你不感興趣也沒關(guān)系，請?jiān)L問FightPharma.org/senate。
在那里你可以寫信給參與這個(gè)決定的參議員。
講述你的故事，添加個(gè)人評論。
讓他們知道，當(dāng)他們競選連任時(shí)，這個(gè)問題將決定是否獲得選票。

It took me fewer than five minutes.
As I uncover more practical steps that you can take, I’ll let all my wonderful Quora followers know.
Peace.
Edit——
Anyone that wants to throw blame around in the comments can stop right here.
The point of this answer was to empower and inform, not to bash each other’s political points of view or to throw blame around.
The house is burning down, arguing about who should put it out is a waste of time.

我只用了不到五分鐘的時(shí)間。
當(dāng)我發(fā)現(xiàn)更多你可以采取的實(shí)際步驟時(shí)，我會讓我所有優(yōu)秀的Quora粉絲知道。
和平
編輯----
任何想在評論中指責(zé)別人的人都可以在這里停下來。
這個(gè)回答的重點(diǎn)是賦予權(quán)力和信息，而不是抨擊彼此的政治觀點(diǎn)或相互指責(zé)。
房子著火了，爭論誰來滅火是浪費(fèi)時(shí)間的行為。